1003928615 NPI number — CLARE H STARRETT DPM

Table of content: CLARE H STARRETT DPM (NPI 1003928615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003928615 NPI number — CLARE H STARRETT DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARRETT
Provider First Name:
CLARE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003928615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2722 MANATEE AVE W
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-779-1100
Provider Business Mailing Address Fax Number:
941-778-3913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2722 MANATEE AVE W
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-779-1100
Provider Business Practice Location Address Fax Number:
941-778-3913
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO 1475 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33875 . This is a "HARVARD PILGRIM HPHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00021053101 . This is a "UNIVERA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6200972 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65322 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V78546 . This is a "AMERIHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 116418 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 480018087 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N408633 . This is a "STAYWELL HEALTHEASE WELLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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